A Retrospective Examination of Referral Patterns to Physical Therapy After Concussion: Have We Kept Up with Current Guidelines?
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 41391615.
- Also identified by DOI 10.1016/j.apmr.2025.11.035.
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Abstract
The study goals were to 1) identify the typical time from a concussion injury to initial physical therapy (PT) evaluation, and 2) explore concussion subtypes (complexity) across time (diagnosis visit versus PT evaluation). We anticipated the median time from concussion to PT evaluation would be 61 days, and that greater time from injury to PT evaluation would be associated with greater symptom complexity. We also explored demographics and referral patterns to PT. Retrospective chart review. Academic medical center. A convenience sample of patients seen in PT for concussion from 3/1/2023 to 12/31/2024 with no hospitalization from concussion and no skull fracture. Two hundred and four charts were reviewed and 100 met inclusion criteria. Patients were 46.0 (±15.0) years old and 67% percent female. The most common mechanism of injury was motor vehicle accident (43%). Not applicable. Days from concussion injury to initial PT evaluation, number of concussion subtypes (range 0-7) at diagnosis and PT evaluation, departments diagnosing concussion and referring to PT, and mechanism of injury. The median [range] time from injury to diagnosis was 5 [0-64] days, and median time to PT evaluation was 58 [5-339] days. The mean number of subtypes at diagnosis was 3.24 (±1.59), which was significantly less than at PT evaluation which was 4.32 (±1.36). There was no association between number of subtypes and days to PT evaluation. Primary Care provided the most diagnoses and referrals to PT, followed by Emergency Department (diagnosis) and Sports Medicine (referrals). The time to PT evaluation was similar to that found in other studies conducted prior to publication of recent concussion guidelines. This continued delay in being seen by PT may be due to lack of awareness of concussion guidelines by non-specialty providers, and limited availability of concussion specialist therapists contributing to long appointment wait times.